Trainer-trainee Relationship Research Articles

Shaping psychotherapy trainees' potential: insights from training program directors.

The role of the therapist has received growing attention in psychotherapy research, suggesting that training effectiveness may also depend on the person of the trainees, with relevant implications in terms of candidate selection or tailoring training to the person. In the present study, we focused on how and how much psychotherapy training can be effective in fostering trainees' characteristics associated with successful therapists and contrast trainees' characteristics that could represent limitations as therapists. The aim was to explore training program directors' perspectives on individual trainees' limitations and strengths, and on the effectiveness of training in shaping successful therapists. To this aim, we interviewed 14 training program directors with different psychotherapy approaches. Audio recordings of these semi-structured interviews were transcribed verbatim and analysed using NVivo software. According to our findings, transversally to different psychotherapy approaches, trainees' self-awareness and the ability to embrace uncertainty were recognized as the main characteristics of good trainees. Four training elements were fre- quently mentioned by directors as effective in shaping trainees' development: experiential learning, the use of paradigm that pri- oritizes self-awareness (instead of technique-focused approaches), the centrality of supervision and inter-vision, the trainer-trainee relationship. These insights highlight the importance of trainees' self-awareness and the ability to embrace uncertainty as potential personal variables that may influence the effectiveness of future psychotherapists and suggest giving attention to experiential learning and training relationships as crucial elements of psychotherapists' development during the training.

An Exposure-Based Intervention Dismantles College-Aged Females’ Barriers for Resistance Training: Project WONDER Training

This study aimed to examine the effects of an exposure-based resistance training (RT) intervention on perceived barriers, benefits, and motives for RT in college-aged females and to assess moderating effects of a trainer-trainee relationship on any intervention outcomes. A sample of 13 (Mage = 20.7 ± 1.3y) physically active, non-resistance training female students completed an 8-week intervention (1hr 45min, twice per week). The intervention was effective in reducing perceived time/effort (t[12] = 5.02, p < 0.001, d = 1.81), physical effect (t[12] = 2.48, p = 0.029, d = 0.86) and social (t[12] = 4.86, p < .001, d = 1.97) RT barriers. A positive change pattern was established in stress management (t[12] = 2.21, p = 0.048, d = 0.62), revitalization (t[12] = 2.71, p = .019, d = 0.95), and enjoyment (t[12] = 3.53, p = .004, d = 1.18). Finally, the analyses showed that goal (β = 0.23[0.02], p < 0001, R2 = 0.979) and bond (β = 0.21[.01], p < 0001, R2 = 0.995) alliances were positive moderators with large-sized effects on changes in physical barriers. For stress management, bond alliance was the only statistically significant, small-sized moderator, with a greater bond increasing the effect on the intervention (β = 0.21[.01], p < 0001, R2 = 0.997). This data suggests that an exposure-based RT intervention is beneficial for reducing perceived RT barriers in physically active, non-resistance training college-aged women and that bond-oriented support from the trainer is especially impactful in reducing some of those perceived barriers.

Rethinking role models in general practice.

Role models have traditionally been seen as more senior professionals who are perceived as exemplary and worthy of imitation. They influence and teach by example and are an aspect of our culture that we easily take for granted. They are timeless, and healthy societies throughout history have depended on them. Osler adopted role models from an early age, under whose influence he developed a passion for natural history and a discipline of scrupulous observation. The General Medical Council states: ‘Doctors who train other doctors are critical to developing and improving standards of care — they help shape the next generation of doctors and are important role models for medical students and doctors in training.’ 1 This process of observation, emulation, experimentation, and assimilation is vital for the development of generalist expertise. However, role models have received less attention than the other two essential elements of effective medical education: organised teaching and structured experiences. Role models are of great importance in all education and complement the explicit mentorship relationship GP trainers have with their trainee when they ask questions and give advice.2 The trainer–trainee relationship is probably the most important single variable affecting a trainee’s progress. Observation allows the trainee to ask, ‘What would X do?’ This holds true for important areas of practice such as prescribing. Albert Bandura, an influential professor of psychology at Stanford wrote: ‘Learning would be exceedingly laborious, not to mention hazardous, if people had to rely solely on the effects of their own actions to inform them what to do. Fortunately, most human behaviour is learned observationally through modelling: from observing others one forms an …

Mo1989 CONCEPTUALIZING ENTRUSTMENT IN ENDOSCOPIC TRAINING

Competency-based medical education (CBME) is a novel educational paradigm being instituted around the world. CBME places emphasis on the development of measurable skills during training rather than time spent in training. A common element of CBME systems is entrustment – the process whereby supervisors come to trust trainees to perform specific tasks without supervision. How entrustment decisions are made with respect to endoscopic training has not been elucidated. We aimed to: (1) identify the factors trainers consider in making endoscopic entrustment decisions and (2) characterize this entrustment decision-making process. A qualitative, interview-based study was conducted using a constructivist grounded theory approach. A purposive sample of endoscopic trainers from across North America were recruited with representation from pediatric and adult gastroenterology, general surgery, and family medicine. Consenting endoscopic trainers undertook audio-recorded, semi-structured interviews designed to elicit how they make endoscopic entrustment decisions and the factors they consider in making these decisions. Interview transcripts were analyzed using constant comparison and themes were identified iteratively, working toward an explanatory framework that highlighted relationships among themes. Recruitment continued alongside analysis until theoretical saturation, determined as the point at which no new insights arose from the data. Twenty-nine trainer interviews were conducted, comprising 9 (31.0%) with pediatric gastroenterologists, 10 (34.5%) with adult gastroenterologists, 7 (24.1%) with general surgeons, and 3 (10.3%) with family physicians. Of those interviewed, 18 (62.1%) practiced in the United States and 11 (37.9%) practiced in Canada. Trainer supervisory experience ranged from <1 to 36 years. Interviewees conceptualized entrustment as a continuum rather than a binary (yes/no) decision. Entrustment was found to be a complex process, involving factors related to the: (1) trainee (insight into own abilities, technical skills, nontechnical skills); (2) trainer (perceived self-competence, disposition, prioritization of trainee learning relative to competing demands); (3) trainer-trainee relationship (familiarity); (4) patient (acuity, comorbidity, comfort); (5) procedure (complexity); and (6) environment (time constraints, equipment, presence of anesthesiologist). These factors directly and indirectly contributed to trainee readiness, trainer comfort, and patient safety; themes which were identified as central to supervisors’ endoscopic entrustment decisions. Entrustment in endoscopic training is a complex process incorporating multiple factors. Clarification of this process and identification of predictive factors informs the development of endoscopic assessment tools and curricula uniquely suited to CBME.

Saudi Nurses' Competency Learnings and Experiences from the Newly Developed Advanced Nursing Practice Diploma Program in Saudi Arabia: A Phenomenological Study.

Introduction In response to Saudi Vision 2030, the Saudi Commission for Health Specialties has taken the lead in supporting healthcare system development by providing advanced nursing practice training diplomas. The aim of this study is to explore the experience of nursing trainees during their enrollment in the newly established Saudi Commission for Health Specialties (SCFHS) Advanced Nursing Practice (ANP) diplomas.Methods We employed a descriptive phenomenological approach in this study. Collaizi’s distinctive process was utilized as a guide for the data analysis of 12 interviews.ResultsExploring the participants’ experiences revealed four themes: (1) the organizational culture valuing the learner and their learnings; (2) the commitment to continuous quality care improvement; (3) challenges in the trainer-trainee relationship; and (4) the vague career track of the trainees.ConclusionThe identified challenges faced by the nursing trainees may hinder the optimum utilization of these program outcomes. Interventions to overcome the identified challenges should be initiated by all stakeholders.

A138 CONCEPTUALIZING ENTRUSTMENT IN ENDOSCOPIC TRAINING

Abstract Background Competency-based medical education (CBME), an educational paradigm that prioritizes development of measurable skills over time in training, is currently being instituted across North American residency training programs. A fundamental goal of CBME is entrustment – the process whereby supervisors come to trust trainees to perform specific tasks without supervision. How entrustment decisions are made with respect to endoscopic training has not been elucidated. Aims We aimed to: (1) identify the factors trainers consider in making endoscopic entrustment decisions and (2) characterize this entrustment decision-making process. Methods A qualitative, interview-based study was conducted using a constructivist grounded theory approach. A purposive sample of endoscopic trainers from across North America were recruited with representation from adult and pediatric gastroenterology, general surgery, and family medicine. Consenting trainers undertook audio-recorded, semi-structured interviews designed to elicit how they make endoscopic entrustment decisions and the factors they consider in making these decisions. Interview transcripts were analyzed using constant comparison, and themes were identified iteratively, working toward an explanatory framework that highlighted relationships among themes. Recruitment continued alongside analysis until theoretical saturation, determined as the point at which no new insights arose from the data. Results Twenty-three trainer interviews were conducted, comprising 8 (34.8%) with adult gastroenterologists, 7 (30.4%) with general surgeons, 6 (26.1%) with pediatric gastroenterologists, and 2 (8.7%) with family physicians. Of those interviewed, 10 (43.5%) practiced in Canada and 13 (56.5%) practiced in the United States. Interviewees conceptualized entrustment as a continuum rather than a binary (yes/no) decision. Entrustment decision-making was found to be a complex process, involving factors related to the: (1) trainee (insight into their own abilities, technical skills, nontechnical skills); (2) trainer (perceived self-competence, disposition, prioritization of trainee learning relative to competing demands); (3) trainer-trainee relationship (duration of exposure); (4) patient (acuity, comorbidity, comfort); (5) procedure (complexity); and (6) environment (time constraints, equipment, presence of anesthesiologist). These factors directly and indirectly contributed to the themes of trainee readiness, trainer comfort, and patient safety, which collectively predicted endoscopic entrustment decisions. Conclusions Entrustment in endoscopic training is a complex process incorporating multiple factors. Clarification of this process and identification of predictive factors informs the development of endoscopic assessment tools and curricula uniquely suited to CBME. Funding Agencies CAG

Satisfaction of the Irish Trauma and Orthopaedic training programme with the Intercollegiate Surgical Curriculum Programme

Surgical training has undergone extensive changes in recent years. The Intercollegiate Surgical Curriculum Programme (ISCP) has been utilised in the UK for many years to facilitate the education and assessment of trainees. It was adopted by the Irish Trauma and Orthopaedics (T&O) training programme in July 2015. This study sought to evaluate the use satisfaction with ISCP in the Irish context. A total of 58 T&O trainers and trainees undertook a paper-based survey during national training days in March and April2017. Eighty-nine percent of trainees responded to the survey along with 85% of trainers. Seventy-nine percent of respondents had been using ISCP for over a year. Most aspects of ISPC were rated as average, with the induction process, online multi-source feedback (MSF) and overall user friendliness rating poorly amongst respondents. Seventeen percent felt that ISCP had a positive impact on training, while 66% felt that it did not adversely affect their training opportunities. Forty-three percent reported a negative impact on the trainer-trainee relationship with adoption of ISCP and only 24% felt that the educational feedback was improved with the new system. Forty-two percent agreed that ISCP created a more structured and supervised framework to the training scheme. Our survey demonstrated significant concerns and reservations amongst the Irish users of ISCP. The demonstrable level of trainee dissatisfaction with ISCP may represent a frustration that key problems such as the regulated training content of jobs remains unaddressed while ISCP does little to improve meaningful formative feedback.

Multi-stakeholder perspectives on information communication technology training for older adults: implications for teaching and learning

Objectives: The objective of this research was to identify and conceptualize barriers and strategies for effective implementation of information communication technology (ICT) training for older adults.Methods: A grounded theory approach was used to collect and analyze qualitative data from 61 participants in three stakeholder groups: older-adult ICT trainees, care providers and ICT trainers.Results: Care providers expressed older adults’ reluctance, lack of affinity, fears and socio-contextual attributes as barriers to overcome with ICT training. ICT trainers highlighted motivation, trainer–trainee relationship, patience, self-reliance and mutual value as strategic themes. ICT trainees elucidated occupational accomplishment, challenges and a sense of competence as themes from their experience with training.Discussion: While digital literacy and skill building have traditionally been the key focus of ageing-centred ICT training, a deeper approach to address internal (personal) and external (socio-contextual) barriers, as conceptualized in the study finding, is vital in yielding successful outcomes.Implications for rehabilitationInformation communication technology (ICT) is a vital resource for older adults to age-in-place and for health professionals in delivery of tele-rehabilitation.Family members and care providers realize the scope of ICT for ageing-in-place but raise doubts on the inherent motivation and abilities of older adults to adopt ICT.On the other hand, older adults who engage in one-on-one ICT training value their new-found sense of accomplishment and competence in using the Internet and social media.Graduate students who provided the training greatly appreciate their own learning experience, and stress the need for mutual trust, patience and simplicity in teaching ICT.A major precursor to imparting digital literacy and skills in older adults who lack ICT exposure is to help them overcome deep-seated attitudinal and socio-contextual barriers through a one-on-one approach.

“It’s More than Doing Sports Together, You Know. It’s Deeply Personal”: Preliminary Findings of an Ongoing Qualitative Study on the Relationships between Personal Fitness Trainers and Trainees

Training at the gym has become, without question, one of the most popular leisure pursuits in contemporary Western societies. In addition to conventional forms of fitness training with free weights, on machines or in exercise-to-music classes, more and more gym members decide to work out with a certified personal trainer on a one-to-one basis, often over long periods of time. The purpose of this ongoing study is to explore the relationship between personal fitness trainers and trainees with a focus on their subjective experiences. Eight semi-structured, indepth interviews were conducted so far and analysed through a thematic analysis. Two central themes have emerged from the data: First, the trainer-trainee relationship is for both sides more than a transactional event but an emotionally significant encounter. Second, trainees describe an occasional reversal of roles where they show interest in and concern about the trainer. Future research should account for possible gender differences, changes of relational dynamics over time and possible negative experiences of both trainers and trainees.

How to Get the Most Out of Your GP Tutorials

GP tutorials, together with General Practice Vocational Training Scheme teaching and on-the-job experience, form the bedrock of general practice training. All GPs in training working in GP practices experience regular one-to-one tutorials with a named GP trainer. These provide both educational and clinical supervision. However, one-to-one tutorials are a relatively new experience for many trainees used to larger group teaching based in hospitals. Moreover the proximity and longevity of the GP trainer-trainee relationship is unique within medicine. The one-to-one setting has its benefits and also disadvantages. This article aims to look closely at the pros and cons of the one-to-one tutorials, with a view to helping both trainees and trainers get the most out of them.

El portafolio del libro del especialista en Medicina de Familia en formación: grado de implementación y opiniones de residentes y tutores 2 años después de su implantación en una unidad docente

Aims To find out to what extent The “Reflective Practice Guide” (RPG) (a semi-structured Portfolio guide) has been implemented in a Spanish Family Medicine Vocational Training Region (Unidad Docente Provincial) and the opinions of trainees and trainers after using it in actual conditions. Design Cross-sectional study Setting A Provincial Family Medicine Teaching Unit (a Spanish Vocational Training Region) Participants 43 trainers and 70 residents (trainees). Methods The participants carried out a formative assessment for 12 months on the competency areas described in the RPG. The information was collected by means of specific card notes. Trainers and Trainees filled in an ad hoc survey. Results The trainees carried out 295 (80%) tasks and reflections out of those recommended in the GPR. First and third year trainees completed 81/108 (75%) and 65/108 (60%) of the tasks, respectively. Trainees and trainers considered that the new method is useful for reflecting on clinical practice, for knowing their own competencies better and for strengthening the trainer-trainee relationship. Conclusions The GPR is a formative tool that trainees carried out with their trainers even to a greater extent than that recommended by the GPR. Both groups perceive this tool as useful for effectively reflecting the trainees practice and for strengthening their relationship

What’s Another Year? a Qualitative Evaluation of Extension of General Practice Training in the West of Ireland

Vocational training in general practice has been shown to be effective in developing skilled, competent, independent practitioners. Nevertheless, many commentators have suggested that the traditional three-year training programme in the UK and Ireland does not prepare general practice registrars (GPRs) fully for independent practice and that extension of the general practice component of training would enhance capability development. This study describes the experience of one Irish training programme (the Western Area Training Programme in General Practice) during its transition from a three- to a four-year programme. This study used focus group interviews to compare and contrast the expectations and experiences of three distinct groups: General practitioners (GPs) who completed the traditional three-year training programme and were interviewed after one year of independent practice. GPRs who were the first entrants into the new extended year of training who were interviewed at the beginning and at the end of the year. GP trainers who were the first trainers involved in the extended year of training who were also interviewed at the beginning and at the end of the year. The registrars who completed the extra year felt better prepared for independent practice than their counterparts who had completed the traditional shorter scheme, due mainly to an increased sense of professional confidence, a broader experience of different practice approaches, a greater knowledge of practice management and the additional career guidance received during their final year. Trainers and registrars described a different type of training relationship in the fourth year. The relationship could be described as more one of mentorship than a traditional trainer-trainee relationship. The customized design of the year provided an easier transition into independent practice than the sudden change experienced in the traditional programme but trainers felt that the flexibility offered could create unrealistic expectations of the reality of finding time for continued learning in general practice. Future research is suggested including followup studies of extended programmes to assess whether the apparent benefits detected in this study influence subsequent personal and practice development. It would also be valuable to explore the effects of the extended programme on the other stakeholders such as the programme directing team, the patients and other training practice team members.

Attributes of an effective trainer: implications of the views of U.K. dermatology trainees

Trainers have a critical influence on the education of specialist registrars (SpRs) and the quality of training programmes. This study gathered the opinions of U.K. dermatology SpRs on the attributes they felt were important in a trainer. The questionnaire was sent to all U.K. dermatology SpRs (n=216). It comprised the stem: 'A good trainer (supervising consultant or educational supervisor)', followed by statements such as '...has realistic expectations of the trainee'. Respondents ranked each statement in importance using a five-point Likert scale. A free-text box was also included for respondents to list the least desirable attributes. Completed questionnaires were received from 146 trainees (68%). Four attributes were identified as most important: having an encouraging and supportive attitude, using feedback to identify specific areas for attention, being approachable, and being willing to answer questions. Least important attributes included openness to criticism of teaching skills, auditing of own clinical practice, sense of humour and place of work (district general vs. teaching hospital). Eighty-seven respondents indicated the least desirable attributes of a trainer. Most comments related to being uninterested in training, being unapproachable or unavailable, or undermining the trainee and using unconstructive criticism. The results highlight the importance to trainees of constructive feedback, and dialogue with trainers. Some of the stated undesirable characteristics in a trainer appeared to derive from personal experience. This is of serious concern, and ways in which the trainer-trainee relationship can be improved are discussed.

Insights into training and examination performance from the first UK National Public Health Training Audit

To investigate predictors of a supportive training relationship and examination success using data from the first UK Public Health Training Audit. Secondary analysis of data from a national cross-sectional survey of UK public health trainees, conducted in April 2003. All UK public health trainees were sent a questionnaire including questions on training experience and examination performance. Possible predictive factors of a supportive trainer-trainee relationship and success at Part I and Part II of Membership of Faculty of Public Health examinations were first investigated in univariate analyses, and subsequently using logistic regression. Two hundred and ninety responses were received (62% response). Supportive trainers gave feedback [odds ratio (OR) = 11.2, 95% confidence interval (CI) 3.7-34.0, P<0.001], spent at least 1 h/week with their trainee (OR = 5.2, 95% CI 1.7-15.4, P = 0.003), held 3-monthly progress meetings (OR = 2.9, 95% CI 1.4-6.1, P = 0.006), and encouraged wide training experience (OR = 2.5, 95% CI 1.2-5.4, P = 0.016). Predictors of success in the Part I examination by the end of the second year of training were medical background (OR = 4.4, 95% CI 1.6-12.2, P = 0.004) and perceived adequacy of examination support (OR = 4.2, 95% CI 1.7-10.0, P = 0.001). Predictors of success in the Part II examination by the end of the fourth year of training were access to examiners (OR = 4.6, 95% CI 1.3-16.2) and wide experience (OR = 4.1, 95% CI 1.1-14.5). Trainees feel supported when provided with adequate trainer contact time, feedback and wide experience. Part I examination success appears to be more likely amongst trainees with a medical background and those given examination support. Part II success is related to the breadth of a trainee's experience and access to examiner support.

Trainer–Trainee Bullying

This paper considers the abuse of the trainer–trainee relationship by the trainer. Such abuse occurs in the context of power and gender imbalances and is afforded little attention by professional organizations. A specific example of inappropriate behaviour between trainers and trainees, that of sexual contact, is discussed in detail. Research on positive and negative supervision is considered in terms of a model of objectionable supervisory styles, and it is suggested that trainer–trainee bullying is an area which requires further research attention. © 1997 John Wiley & Sons, Ltd.

The Madam as Teacher: The Training of House Prostitutes

Although the day of the elaborate and conspicuous high-class house of prostitution is gone, houses still operate throughout the United States in a variety of altered forms. The business may be run out of trailers and motels along major highways, luxury apartments in the center of a metropolis or run-down houses in smaller, industrialized cities. (Recent discussions of various aspects of house prostitution include: Gagnon and Simon, 1973:226-7; Hall, 1973: 115-95; Heyl, 1974; Jackson, 1969:185-92; Sheehy, 1974:185-204; Stewart, 1972; and Vogliotti, 1975:25-80.) Madams sometimes find themselves teaching young women how to become professional prostitutes. This paper focuses on one madam who trains novices to work at the house level. I compare the training to Bryan's (1965) account of the apprenticeship of call girls and relate the madam's role to the social organization of house prostitution. Bryan's study of thirty-three Los Angeles call girls is one of the earliest interactionist treatments of prostitution. His data focus on the process of entry into the occupation of call girl and permit an analysis of the structure and content of a woman's'apprenticeship.He concluded that the apprenticeship of call girls is mainly directed toward developing a clientele, rather than sexual skills (1965:288, 296-7). But while Bryan notes that pimps seldom train women directly, approximately half of his field evidence in fact derives from pimp-call girl apprenticeships. Thus, in Bryan's study (as well as in subsequent work on entry into prostitution as an occupation) there is a missing set of data on the more typical female trainer-trainee relationship and on the content and process of training at other levels of the business in nonmetropolitan settings. This paper attempts to fill this gap.